R E S E A R C H Open AccessHuman herpesvirus-8 in northwestern China: epidemiology and characterization among blood donors Xing Wang1, Bin He2, Zhaoxia Zhang1, Tao Liu1, Hui Wang1, Xu Li
Trang 1R E S E A R C H Open Access
Human herpesvirus-8 in northwestern China:
epidemiology and characterization among blood donors
Xing Wang1, Bin He2, Zhaoxia Zhang1, Tao Liu1, Hui Wang1, Xu Li3, Qiong Zhang1, Ke Lan4, Xiaomei Lu1,
Hao Wen1*
Abstract
Background: Human herpes virus 8 (HHV-8) is the etiologic agent associated with development of classical, AIDS-related, iatrogenic, and endemic Kaposi’s sarcoma (KS) Several studies provide strong evidence that HHV-8 can be transmitted by blood transfusion We evaluated the seroprevalence and potential risk factors of HHV-8 infection in blood donors in one region We surveyed HHV-8 infection among 4461 blood donors in Xinjiang, China, a unique endemic area for HHV-8 and KS
Results: The HHV-8 seroprevalence was higher in local minority groups which comprise most KS cases in China, than in Han people HHV-8 prevalence was 18.6% in the Han ethnic group, 25.9% in Uygur subjects, 29.2% in Kazak subjects, 36.8% in Mongolian subjects, and 21.9% in other ethnic groups In several subgroups, the time of
donation of whole blood seemed to be a risk factor In HHV-8-seropositive subjects, a larger fraction of local
minorities (23.9%) had high HHV-8 titers than that of Han subjects (9.2%) HHV-8 infection was associated with ethnicity and residence
Conclusion: HHV-8 seroprevalence was significantly high among blood donors in Xinjiang, where the prevalence
of KS correlates with HHV-8 prevalence and titers in Uygur and Kazak ethnic groups Blood exposure represented
by the frequency of blood donation indicated a possible blood-borne transmission route of HHV-8 in Xinjiang Detecting anti-HHV-8 antibodies before donation in this region is therefore important
Background
Human herpes virus 8 (HHV-8) is the etiologic agent
associated with the development of classical,
AIDS-related, iatrogenic, and endemic Kaposi’s sarcoma (KS)
[1,2] HHV-8 is also associated with lymphoproliferative
diseases, including primary effusion lymphomas and
multicentric Castleman’s disease [3,4] Emerging
evi-dence suggests that HHV-8 may be transmitted through
sexual contact [5,6], saliva [7], and blood transfusion
[8-10] In the USA, where HHV-8 seroprevalence is low
(<10%), HHV-8 is spread by the sexual route, at least
among homosexual men [5,6] In regions or countries
with high HHV-8 seroprevalence (>25%), HHV-8
infec-tion increases throughout childhood, suggesting that
transmission occurs through saliva or other horizontal routes [11-13] Of note, HHV-8 infection has been observed in patients who received non-leukocyte-reduced blood [8] Infectious viruses or viral DNA have been identified from blood donors in the USA and Africa [14,15] HHV-8 infection has been observed in patients receiving blood transfusions in Uganda, thereby indicating blood-borne transmission of HHV-8 [9,10] HHV-8 seroprevalence among blood donors varies between different regions HHV-8 prevalence ranges from 0.2% in Japan, 0-15% in the USA and the UK, up
to >50% in some African countries [16,17] There is a wide range of variations in HHV-8 infection in South America [18] A few studies focusing on small study populations have been carried out in China In the inland areas of China, HHV-8 seroprevalence in general population was <8% [19,20] In Xinjiang, in the north-west of China, HHV-8 seroprevalence ranged from
* Correspondence: wangxing7610@yahoo.com.cn
1 First Teaching Hospital of Xinjiang Medical University, Urumqi, Xinjiang,
PR China
© 2010 Wang et al; licensee BioMed Central Ltd This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
Trang 212.5% to 48% depending on different populations
[21-24] The mode of HHV-8 transmission remains
undefined, but the unique pattern of HHV-8 infection
in this geographic region correlated well with an
increased incidence of KS [21,22,24]
Results
Demographic patterns of HHV-8 seroprevalence among
blood donors
A total of 4461 serum samples from blood donors were
analyzed Demographic patterns and blood
donation-associated behavioral characteristics of HHV-8 infection
are shown in Tables 1 and 2, respectively Overall, 3551 subjects were HHV-8-negative (79.6%) whereas 910 par-ticipants were HHV-8-positive (20.4%) In this popula-tion, there was no significant difference in HHV-8 seroprevalence with respect to sex, age, marriage, occu-pation, education, blood type, and times of donation of blood components Xinjiang residents exhibited HHV-8 seroprevalence of 21.3%, whereas the value for non-resi-dents was 17.7% The latter were all of Han extraction who had migrated to Xinjiang from inland areas There was a difference among ethnic groups HHV-8 seropre-valence in the Han population was lower (18.6%) than
Table 1 Sociodemographic characteristics by HHV-8 seroprevalence
Characteristics Number of subjects (%) HHV-8 sero-positivity (%) OR (95% CI) p
Male 2662 (59.7) 533 (20.0)
Female 1799 (40.3) 377 (21.0)
Han 3386 (75.9) 629 (18.6)
Uygur 526 (11.8) 136 (25.9) 1.5 (1.2-1.9) 0.000* Kazak 161 (3.6) 47 (29.2) 1.8 (1.3-2.6) 0.001* Mongolian 87 (2.0) 32 (36.8) 1.0 (1.6-4.0) 0.000* Other 301 (6.7) 66 (21.9) 2.6 (0.9-1.6) 0.155
19-24 2076 (46.5) 430 (20.7)
24-29 904 (20.3) 166 (18.4) 0.9 (0.7-1.1) 0.141 29-34 590 (13.2) 120 (20.3) 1.0 (0.8-1.2) 0.843 34-39 489 (11.0) 102 (20.9) 1.0 (0.8-1.3) 0.843 39-44 245 (5.5) 56 (22.9) 1.1 (0.8-1.6) 0.436 44-49 105 (2.4) 24 (22.9) 1.1 (0.7-1.8) 0.598 49-54 43 (1.1) 10 (23.3) 1.2 (0.6-2.4) 0.684
>54 9 (0.2) 2 (22.2) 1.1 (0.2-5.3) 0.911 Martial status 1.1 (0.9-1.3) 0.301 Unmarried 3078 (69.0) 615 (20.0)
Ever married 1383 (31.0) 295 (21.3)
Soldier 157 (3.5) 25 (15.9)
Student 1290 (28.9) 276 (21.4) 1.4 (0.9-2.2) 0.112 Professional specialty 740 (16.6) 159 (21.5) 1.4 (0.9-2.3) 0.118 Business\service 697 (15.6) 125 (17.9) 1.0 (0.7-1.8) 0.550 Unidentified job 1577 (35.4) 325 (20.6) 1.3 (0.9-2.1) 0.165
College 1034 (23.2) 217 (21.0)
Junior College 1080 (24.2) 237 (21.9) 1.0 (0.9-1.3) 0.592 Technical Secondary School 459 (10.3) 79 (17.2) 0.8 (0.6-1.0) 0.092 Senior High School 935 (21.0) 197 (21.1) 1.0 (0.9-1.2) 0.964 Junior High School 844 (18.9) 162 (19.2) 0.9 (0.7-1.1) 0.336 Elementary School 109 (2.4) 18 (16.5) 0.3 (0.3-0.9) 0.273 Residence 1.3 (1.1-1.5) 0.009* Xinjiang 3321 (74.4) 708 (21.3)
Outside of Xinjiang 1140 (25.6) 202 (17.7)
Total 4461 (100.0) 910 (20.4)
Trang 3in any other ethnic group, such as Uygur (25.9%), Kazak
(29.2%), Mongolian (36.8%) and others (21.9%) HHV-8
seroprevalence tended to increase among local minority
groups Most individuals were blood donors, who were
negative for hepatitis-B virus (HBV), hepatitis-C virus
(HCV), human immunodeficiency virus (HIV), and
syphilis (99.8%) Among seven positive subjects for these
pathogens, three were HHV-8-positive individuals
(42.9%) The relevance of HBV, HCV, HIV, and syphilis
to HHV-8 seroprevalence was not further analyzed
because the small sample size
Assessment of risk factors
The univariate associations between HHV-8
seroprave-lence and subject characteristics are illustrated in Tables
1 and 2 Ethnic background was found to be associated
with HHV-8-positive status This variable exhibited a
statistically significant difference whereby the odds ratio
(OR) was high for Uygur (1.5, 95% confidence interval
(CI) 1.2-1.9, p < 0.000) and Kazak (1.8, 95% CI 1.3-2.6,
p < 0.001) ethnic groups Residence appeared to be
associated with HHV-8 infection (OR = 1.3, 95% CI
1.1-1.5, p < 0.009) No associations were observed between
HHV-8 seroprevalence and sex, age, education, marital
status, occupation and blood donation-associated
behaviors To further identify independent risk factors, all variables from the univariate analysis were entered into multiple logistic regression models (Table 3) In this analysis, HHV-8-positive status was associated with Uygur (OR = 1.4, 95% CI 1.1-1.9, p < 0.000) and Kazak (OR = 1.8, 95% CI 1.2-2.6, p < 0.000) ethnic groups
Table 2 HHV-8 seroprevalence by blood donor-associated behaviors
Characteristics Number of subjects (%) HHV-8 sero-positivity (%) OR (95% CI) p Type of blood donation 1.0(0.7-1.4) 0.962 Whole blood 4232 (94.9) 863 (20.4)
Blood component 229 (5.1) 47 (20.5)
Time of donation of whole blood 0.845
1 2702(63.8) 557 (20.6)
2 851 (20.1) 176 (20.7) 1.0 (0.7-1.4) 0.958
3 352 (8.3) 76 (21.6) 0.0 (0.7-1.4) 0.758
4 168 (4.0) 25 (14.9) 1.1 (0.7-1.6) 0.151
5 67 (1.6) 13 (19.4) 0.7 (0.4-1.2) 0.841
6 39 (0.9) 7 (17.9) 0.9 (0.5-1.9) 0.711
7 25 (0.6) 4 (16.0) 0.8 (0.4-2.0) 0.593
8 28 (0.7) 5 (17.9) 0.7 (0.2-2.3) 0.740 Time of donation of blood components 0.678 1-5 64 (27.9) 13 (20.3)
6-10 29 (12.7) 10 (34.5) 1.0 (0.5-1.8) 0.067 12-15 33 (14.4) 6 (18.2) 2.1 (1.0-4.4) 0.987 16-20 24 (10.5) 4 (16.7) 0.9 (0.4-2.1) 0.754 21-25 19 (8.3) 2 (10.5) 0.8 (0.3-2.3) 0.652 26-30 26 (11.4) 5 (19.2) 0.5 (0.1-2.0) 0.299 31-40 20 (8.7) 3 (15.0) 0.9 (0.7-2.5) 0.884 41-44 14 (6.1) 4 (28.6) 0.7 (0.2-2.4) 0.553 Pathogens screen 0.0 (0.0-1.0) 0.982 Seronegative 4452 (99.8) 907 (20.4) 2.9(0.7-13.1) 0.159 Seropositive 7 (0.2) 3 (42.9)
(HBV/HCV/HIV/syphilis)
Table 3 Analyses by risk factor
OR (95% CI) p Ethnic background 0.000*
Uygur 1.4 (1.1-1.9) 0.004* Kazak 1.8 (1.2-2.6) 0.004* Mongolian 2.7 (1.7-4.2) 0.000* Other 1.3 (0.9-1.7) 0.142 Time of donation of whole blood 0.185
2 1.2 (0.9-1.7) 0.291
3 1.9 (1.1-3.2) 0.021*
4 1.5 (0.7-3.0) 0.278
5 3.5 (1.3-9.7) 0.016*
6 4.6 (1.2-17.8) 0.025*
7 4.1 (0.8-20.7) 0.089
8 5.1 (1.1-23.9) 0.040*
Trang 4A strong association of HHV-8 infection was seen with
the Mongolian (OR = 2.7, 95% CI 1.7-4.2, p < 0.000)
ethnic group With the increasing frequency of donation
of whole blood, the possibility of infection also increased
in several subgroups such as 3 (OR = 1.9, 95% CI
1.1-3.2, p < 0.021), 5 (OR = 3.5, 95% CI 1.3-9.7, p < 0.016),
6 (OR = 4.6, 95% CI 1.2-17.8, p < 0.025), and 8 (OR =
5.1, 95% CI 1.1-23.9, p < 0.04) There was no association
between HHV-8 seroprevalence and the other variables
evaluated in Tables 1 and 2 (data not shown)
HHV-8 antibody titers in HHV-8-positive individuals
We compared relative levels of HHV-8 antibody titers
among HHV-8-positive subjects High titers were noted
in: 12.2% of those aged <30 years, 13.4% of subjects
aged >30 years, 12% of unmarried individuals, and
13.9% of married individuals (Figure 1) There was no
major difference in these subgroups Among study
sub-jects, 11.9% of individuals who had a Junior High
School-education had high titers This number increased
to 15.6% for those who studied beyond Junior High
School Only 9.2% of HHV-8-positive subjects from the
Han ethnic group had high titers This number
increased to 23.9% in minority groups which included
the Uygur and Kazak ethnic groups As compared with
subjects from the Han ethnic group, local minorities
had a larger proportion of individuals with a higher
level of HHV-8 antibody titers
We further examined HHV-8 antibody titers in each
individual ethnic group The Han group exhibited a
8 seroprevalence of 18.6%, but only 9.2% of
HHV-8-positive subjects had high anti-HHV-8 titers (Figure
2) A similar trend was seen in the Mongolian group
and other groups except the Uygur and Kazak groups
The Mongolian group showed a HHV-8 seroprevalence
of 36.8%, whereas 18.8% had high HHV-8 antibody titers Other groups showed a HHV-8 seroprevalence of 21.9%, whereas 12.1% had high HHV-8 titers Strikingly, different results were seen in Uygur and Kazak groups; 24.3% of the Uygur group with HHV-8 infection had high 8 titers, and 23.4% of Kazak who were
HHV-8 positive had high HHV-HHV-8 titers Therefore, a larger fraction of Uygur and Kazak groups had higher HHV-8 antibody titers than those in the other ethnic groups
Discussion
The present study was the first large-scale survey of HHV-8 seroprevalence in blood donors in China Recent reports showed that HHV-8 seroprevalence was 7.3% in Liaonin province and 5.7% in Shandong province among healthy blood donors [19,25] These studies focused on the Han ethnic group, and the study population was small A study in the Han ethnic group in Hubei pro-vince revealed that HHV-8 seroprevalence was 5.2% [20] The prevalence of HHV-8 infection reported in these studies was similar to those among the adult population in North America [6,14,26] These observa-tions suggest that HHV-8 seroprevalence in China was,
in general, low The Xinjiang area, located in the north-west of China, exhibited a distinct pattern We noted that HHV-8 seroprevalence was relatively high in the Han ethnic group living in Xinjiang: 18.6% of blood donors were HHV-8 positive Moreover, HHV-8 sero-prevalence was 17.7% among the 1140 non-residential Han ethnic group who migrated to Xinjiang from inland areas Thus, an elevated HHV-8 seroprevalence in the Han ethnic group in Xinjiang province implies an asso-ciation of HHV-8 infection with the living environment These potential factors which contribute to the differ-ences within the same ethnic group suggest an increased
Figure 1 Relative HHV-8 high titers in different subgroups among blood donors.
Trang 5opportunity for members of the Han ethnic group to
have close contact with highly infected populations And
the relatively low level of public health in Xinjiang
pro-vince due to the economic situation in this region may
benefit the spread or transmission of HHV-8, but this
hypothesis needs conformation The precise impact of
being resident in Xinjiang on HHV-8 infection could
not be ascertained because of the cross-sectional nature
of the present study
The present study suggested that HHV-8
seropreva-lence was associated with ethnicity but not with sex,
age, marital status, occupation, educational level, blood
type, and time of donation of blood components
Among blood donors, HHV-8 seroprevalence was 18.6%
in the Han group, 25.9% in the Uygur group, 29.2% in
the Kazak group, and 36.8% in the Mongolian group
When combined, the mean prevalence of HHV-8
infec-tion in local minorities was 30.6% Compared with Han
subjects living in Xinjiang, the elevated HHV-8
seropre-valence in local minorities was significant Hence, what
was the basis for the observed differences? It is known
that local minorities have resided in Xinjiang for
genera-tions, and that they have unique cultural practices An
intriguing possibility is that different cultural practices
or social behaviors may play a part in HHV-8 infection
Alternatively, genetic factors may affect the susceptibility
to HHV-8 infection Additional studies are required to
address these issues
Several studies have demonstrated that HHV-8
sero-prevalence is correlated with the occurrence of KS in
Europe and Africa [27-30] In Ghana and Egypt, a high
prevalence of HHV-8 does not correlate well with KS
onset [11,31] HHV-8 seroprevalence is high among
Amerindians in Brazil, French Guiana and Ecuador [32-34] Nonetheless, KS has not been reported for these populations The present study revealed that HHV-8 seroprevalence was higher in Han subjects resid-ing in Xinjiang than in the inland areas of China Furthermore, it was higher in local minority groups than in Han subjects HHV-8 prevalence remained high
in blood donors residing in Xinjiang, but classical KS and AIDS-related KS were observed only among local minority groups [21,22] Taken together, these data sup-port the hypothesis that additional factors other than HHV-8 may be involved in KS development
Several researchers reported blood-borne transmission
of HHV-8 among a large cohort of drug users, or pro-spective studies on blood-transfusion recipients [8,10] The present study was in accordance with these studies because it established a positive relationship between an increasing prevalence of infection with the correspond-ing frequency of donation of whole blood To a certain extent, the time of donation represents the opportunity
of blood exposure In China, laws pertaining to donation
of whole blood were passed in 1992 Before 1992, non-standard protocols for blood collection, and absence of instruments and materials were common These condi-tions could increase the prevalence of HHV-8 infection
by blood exposure A possible explanation for the con-tradictory results in the univariate analysis with respect
to the time of donation of blood components may be due to the small number of samples in each group or undetermined factors
There was a difference in HHV-8 antibody titers among HHV-8-seropositive individuals in the present study Specifically, a larger fraction of local minorities
Figure 2 HHV-8 infection by seroprevalence and high antibody titers in different ethnic groups
Trang 6had high HHV-8 antibody titers than Han subjects This
was evident in the Uygur and Kazak ethnic groups
Whether this reflects enhanced replication of HHV-8 or
enhanced immune responses is not clear Notably, KS
patients are seen in Uygur and Kazak ethnic groups in
Xinjiang hospitals [21,22] The patients are typically
elderly men who have multiple nodular lesions in the
lower or upper extremities Intriguingly, KS patients
tend to be younger among those who are also infected
with HIV Hence, high HHV-8 antibody titers in Uygur
and Kazak groups appeared to correlate with the
devel-opment of KS in these ethnic groups
Conclusions
HHV-8 seroprevalence was significantly high in blood
donors from Xinjiang A critical question relevant to
public health is if HHV-8 is transmitted through blood
transfusion in the Xinjiang area Several studies in the
USA and Africa suggest an association between HH-8
infection with blood transfusion Error! Reference source
not found Given that HHV-8 seroprevalence in the
Xin-jiang area is high, assessing the risk of HHV-8
transmis-sion via blood transfutransmis-sion in future studies is essential
Methods
Ethical approval of the study protocol
The present study was approved by the Institutional
Ethics Committee of the First Teaching Hospital of
Xin-jiang Medical University (Urumqi, XinXin-jiang, China)
Written informed consent was obtained from all
sub-jects, and patient confidentiality was ensured
Study population
A cross-sectional study was designed to assess the
sero-prevalence of HHV-8 infection among blood donors in
Xinjiang, China Serum samples, collected and deposited
from all five blood banks belonging to Xinjiang Blood
Center between August 2006 and May 2007, were
ana-lyzed These samples were derived from 4832 blood
donors belonging to different ethnic groups: Han,
Uygur, Kazak, Mongolian, and others All samples went
through a standard screening for HBV, HCV, HIV, and
syphilis A questionnaire regarding age, sex, ethnicity,
marital status, education and residence was collected Of
4832 blood donors, 4461 blood donors completed all
sections of the questionnaire Serum samples were
cen-trifuged and stored at -80°C before HHV-8 serologic
testing
Laboratory procedures
The coded serum specimens were tested for HHV-8
anti-gens of ORF73, ORF65and K8.1 using enzyme-linked
immunosorbent assays as described22,24Error! Reference
source not found This assay has a sensitivity of 82% and
a specificity of 96%22 Briefly, viral antigen-coated plates were incubated with serum samples diluted at 1:100 This was followed by incubation with goat anti-human immu-noglobulins (including IgG) conjugated with horseradish peroxidase (HRP; Tago Immunologicals) The mean opti-cal density at 450 nm was determined Controls included serum samples derived from KS patients and HHV-8-negative individuals Based on the assays from control groups, the HHV-8-positive cutoff was set to the value that was three-times that of the negative control The HHV-8 high titer was set to the value that was more than five-times that of the negative control
Statistical analyses
All statistical analyses were carried out using SPSS soft-ware version 12.0 (SPSS Incorporated, Chicago, IL, USA) The univariate analysis of categorical variables was evalu-ated by #2 test withP < 0.05 being considered significant Associations revealed by OR and P were evaluated at a
CI of 95% Multivariate logistic regression analysis was carried out to control for confounding factors CI was calculated based on coefficients and standard errors from the logistic model Seropositive prevalence and risk fac-tors were compared between groups
Acknowledgements This work was supported by the Youth Funds of Xinjiang Autonomous Region (grant number 2009211B17) and the Joint Funds of the National Natural Science Foundation of China (30760228).
Author details
1 First Teaching Hospital of Xinjiang Medical University, Urumqi, Xinjiang,
PR China.2Department of Microbiology and Immunology, College of Medicine, the University of Illinois at Chicago, IL 60612, USA 3 Blood Center
of Urumqi, Xinjiang, PR China.4Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, PR China.
Authors ’ contributions
XW carried out study design, sample collection, and statistical analyses performance; she also participated in antibody detection ZZ, TL, QZ and HW also participated in antibody detection XLi and XLu wrote and collected the questionnaire BH drafted the manuscript KL participated in the design of the study and carried out statistical analyses.
HW conceived the study, and participated in its design and coordination; he also helped to draft the manuscript All authors read and approved the final manuscript.
Competing interests The authors declare that they have no competing interests.
Received: 29 November 2009 Accepted: 17 March 2010 Published: 17 March 2010
References
1 Chang Y, Cesarman E, Pessin MS, et al: Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi ’s sarcoma Science 1994, 266:1865-1869.
2 Schalling M, Ekman M, Kaaya EE, et al: A role for a new herpes virus (KSHV) in different forms of Kaposi ’s sarcoma Nat Med 1995, 1:707-708.
3 Cesarman E, Chang Y, Moore PS, et al: Kaposi ’s sarcoma-associated herpesvirus-like DNA sequences in AIDS-related body-cavity-based lymphomas N Engl J Med 1995, 332:1186-1191.
Trang 74 Soulier J, Grollet L, Oksenhendler E, et al: Kaposi ’s sarcoma-associated
herpesvirus-like DNA sequences in multicentric Castleman ’s disease.
Blood 1995, 86:1276-1280.
5 Martin JN, Ganem DE, Osmond DH, et al: Sexual transmission and the
natural history of human herpesvirus 8 infection N Engl J Med 1998,
338:948-954.
6 Engels EA, Atkinson JO, Graubard BI, et al: Risk factors for human
herpesvirus 8 infection among adults in the United States and evidence
for sexual transmission J Infect Dis 2007, 196:199-207.
7 Pauk J, Huang ML, Brodie SJ, et al: Mucosal shedding of human
herpesvirus 8 in men N Engl J Med 2000, 343:1369-1377.
8 Dollard SC, Nelson KE, Ness PM, et al: Possible transmission of human
herpesvirus-8 by blood transfusion in a historical United States cohort.
Transfusion 2005, 45:500-503.
9 Mbulaiteye SM, Biggar RJ, Bakaki PM, et al: Human herpesvirus 8 infection
and transfusion history in children with sickle-cell disease in Uganda J
Natl Cancer Inst 2003, 95:1330-1335.
10 Hladik W, Dollard SC, Mermin J, et al: Transmission of human herpesvirus
8 by blood transfusion N Engl J Med 2006, 355:1331-1338.
11 Andreoni M, El-Sawaf G, Rezza G, et al: High seroprevalence of antibodies
to human herpesvirus-8 in Egyptian children: evidence of nonsexual
transmission J Natl Cancer Inst 1999, 91:465-469.
12 Brayfield BP, Phiri S, Kankasa C, et al: Postnatal human herpesvirus 8 and
human immunodeficiency virus type 1 infection in mothers and infants
from Zambia J Infect Dis 2003, 187:559-568.
13 de Souza VA, Sumita LM, Nascimento MC, et al: Human herpesvirus-8
infection and oral shedding in Amerindian and non-Amerindian
populations in the Brazilian Amazon region J Infect Dis 2007,
196:844-852.
14 Blackbourn DJ, Ambroziak J, Lennette E, et al: Infectious human
herpesvirus 8 in a healthy North American blood donor Lancet 1997,
349:609-611.
15 Belec L, Cancre N, Hallouin MC, et al: High prevalence in Central Africa of
blood donors who are potentially infectious for human herpesvirus 8.
Transfusion 1998, 38:771-775.
16 Antman K, Chang Y: Kaposi ’s sarcoma N Engl J Med 2000, 342:1027-138.
17 Baillargeon J, Deng JH, Hettler E, et al: Seroprevalence of Kaposi ’s
sarcoma-associated herpesvirus infection among blood donors from
Texas Annals Epidemiol 2001, 11:512-518.
18 Mohanna S, Portillo JA, Carriquiry G, et al: Human herpesvirus-8 in
Peruvian blood donors: a population with hyperendemic disease? Clin
Infect Dis 2007, 44:558-561.
19 Wang GQ, Xu H, Wang YK, et al: Higher prevalence of human herpesvirus
8 DNA sequence and specific IgG antibodies in patients with
pemphigus in China J Am Acad Dermatol 2005, 52(3 Pt 1):460-467.
20 Fang Q, Liu J, Q BZ, et al: Seroprevalence of Kapsosi ’s sarcom-associated
herpesvirus in the central population from Hubei provine Viroligica
Sinica 2006, 21:97-101.
21 Dilnur P, Katano H, Wang ZH, et al: Classic type of Kaposi ’s sarcoma and
human herpesvirus 8 infection in Xinjiang, China Pathol Intl 2001,
51:845-852.
22 He F, Wang X, He B, et al: Human herpesvirus 8: serovprevalence and
correlates in tumor patients from Xinjiang, China J Med Virol 2007,
79:161-166.
23 Du W, Chen G, Sun H, et al: Antibody to human herpesvirus type 8 in the
general populations of Xinjiang Autonomous Region Chinese J Exp Clin
Virol 2000, 14:44-47.
24 Fu B, Sun F, Li B, et al: Seroprevalence of Kaposi ’s Sarcoma-associated
Herpesvirus and Risk Factors in Xinjiang, China J Med Virol 2009,
81:1422-1431.
25 Mei Q, Ming ZW, Ping YX, et al: HHV-8 seroprevalence in blood donors
and HIV-positive individuals in Shandong area, China J Infect 2007,
55:89-90.
26 Kedes DH, Operskalski E, Busch M, et al: The seroepidemiology of human
herpesvirus 8 (Kaposi ’s sarcoma-associated herpesvirus): distribution of
infection in KS risk groups and evidence for sexual transmission Nat
Med 1996, 2:918-924.
27 Kedes DH, Ganem D, Ameli N, et al: The prevalence of serum antibody to
human herpesvirus 8 (Kaposi sarcoma-associated herpesvirus) among
HIV-seropositive and high-risk HIV-seronegative women JAMA 1997,
277:478-481.
28 Rezza G, Lennette ET, Giuliani M, et al: Prevalence and determinants of anti-lytic and anti-latent antibodies to human herpesvirus-8 among Italian individuals at risk of sexually and parenterally transmitted infections Intl J Cancer 1998, 77:361-365.
29 Gao SJ, Kingsley L, Li M, et al: KSHV antibodies among Americans, Italians and Ugandans with and without Kaposi ’s sarcoma Nat Med 1996, 2:925-928.
30 Boshoff C, Weiss RA: Epidemiology and pathogenesis of Kaposi ’s sarcoma-associated herpesvirus Phil Trans R Soc Lon Biol Sci 2001, 356:517-534.
31 Ablashi D, Chatlynne L, Cooper H, et al: Seroprevalence of human herpesvirus-8 (HHV-8) in countries of Southeast Asia compared to the USA, the Caribbean and Africa Brit J Cancer 1999, 81:893-897.
32 Biggar RJ, Whitby D, Marshall V, et al: Human herpesvirus 8 in Brazilian Amerindians: a hyperendemic population with a new subtype J Infect Dis 2000, 181:1562-1568.
33 Whitby D, Marshall VA, Bagni RK, et al: Genotypic characterization of Kaposi ’s sarcoma-associated herpesvirus in asymptomatic infected subjects from isolated populations J Gen Virol 2004, 85(Pt 1):155-163.
34 Kazanji M, Dussart P, Duprez R, et al: Serological and molecular evidence that human herpesvirus 8 is endemic among Amerindians in French Guiana J Infect Dis 2005, 192:1525-1529.
doi:10.1186/1743-422X-7-62 Cite this article as: Wang et al.: Human herpesvirus-8 in northwestern China: epidemiology and characterization among blood donors Virology Journal 2010 7:62.
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